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Question 1
Correct
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The parasympathetic supply to the rectum is from which of the following:
Your Answer: Pelvic splanchnic nerves
Explanation:Parasympathetic supply is from the pelvic splanchnic nerves (S2 – S4) and inferior hypogastric plexus.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 2
Correct
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In adults, there are normally how many teeth:
Your Answer: 32
Explanation:In adults, there are 32 teeth, 16 in the upper jaw and 16 in the lower jaw. On each side in both upper and lower arches, there are two incisors, one canine, two premolars and three molar teeth.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 3
Correct
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A 25-year old male is brought to the emergency room after a traffic accident. Upon examination, there was tenderness and erythema on the right acromioclavicular joint, with notable step deformity. On radiographic imaging, there is a superior elevation of the clavicle, a twice than normal coracoclavicular distance, and absence of fracture.Which of the following structure/s is/are likely to have ruptured?
Your Answer: Acromioclavicular ligament, coracoclavicular ligament and joint capsule
Explanation:Acromioclavicular joint injuries account for more than forty percent of all shoulder injuries. Mild injuries are not associated with any significant morbidity, but severe injuries can lead to significant loss of strength and function of the shoulder. Acromioclavicular injuries may be associated with a fractured clavicle, impingement syndromes, and more rarely neurovascular insults.The AC joint is a diarthrodial joint defined by the lateral process of the clavicle articulating with the acromion process as it projects anteriorly off the scapula. The joint is primarily stabilized by the acromioclavicular ligament, which is composed of an anterior, posterior, inferior, and superior component. Of note, the superior portion of the AC ligament is the most important component for the stability of the AC joint. Supporting structures include two coracoclavicular ligaments (trapezoid and conoid ligaments), which provide vertical stability, as well as the coracoacromial ligament.Patients with an AC joint injury typically present with anterosuperior shoulder pain and will describe a mechanism of injury of blunt trauma to the abducted shoulder or landing on an outstretched arm, suggestive of this type of injury. They may describe pain radiating to the neck or shoulder, which is often worse with movement or when they try to sleep on the affected shoulder. On examination, the clinician may observe swelling, bruising, or a deformity of the AC joint, depending on the degree of injury. The patient will be tender at that location. They may have a restriction in the active and passive range of motion secondary to pain. Piano key sign may be seen, with an elevation of the clavicle that rebounds after inferior compression.Standard X-rays are adequate to make a diagnosis of acromioclavicular joint injury and should be used to evaluate for other causes of traumatic shoulder pain.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 4
Correct
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The most important nerve for plantar flexion of the foot at the ankle joint is:
Your Answer: Tibial nerve
Explanation:Muscles of the posterior compartment of the leg, innervated by the tibial nerve, perform plantar flexion of the foot at the ankle joint. The fibularis longus (innervated by the superficial fibular nerve) assists in plantar flexion but is not the most important.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 5
Correct
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A patient suffers an injury to the nerve that innervates piriformis.The piriformis muscle is innervated by which of the following nerves? Select ONE answer only.
Your Answer: Nerve to piriformis
Explanation:Piriformis is innervated by the nerve to piriformis, which is a direct branch from the sacral plexus (S1 and S2).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 6
Correct
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Which of the following nerves supplies the abductor pollicis brevis?
Your Answer: The recurrent branch of the median nerve
Explanation:Abductor pollicis brevis is innervated by the recurrent (thenar) branch of median nerve (root value C8 and T1).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 7
Correct
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Following a road traffic collision, a patient sustains damage to the long thoracic nerve. Which of the following clinical findings would you most expect to see on examination:
Your Answer: Winged scapula deformity
Explanation:Damage to the long thoracic nerve results in weakness/paralysis of the serratus anterior muscle. Loss of function of this muscle causes the medial border, and particularly the inferior angle, of the scapula to elevate away from the thoracic wall, resulting in the characteristic ‘winging’ of the scapula. This deformity becomes more pronounced if the patient presses the upper limb against a wall. Furthermore, normal elevation of the arm is no longer possible.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 8
Correct
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A patient presents complaining of visual loss. On examination you note a contralateral homonymous hemianopia. Where is the most likely site of the lesion:
Your Answer: Optic tract
Explanation:At the optic chiasm, fibres from the medial (nasal) half of each retina crossover, forming the right and left optic tracts.The left optic tract contains fibres from the left lateral (temporal) retina and the right medial retina.The right optic tract contains fibres from the right lateral retina and the left medial retina.Each optic tract travels to its corresponding cerebral hemisphere to reach its lateral geniculate nucleus (LGN) located in the thalamus where the fibres synapse.A lesion of the optic tract will cause a contralateral homonymous hemianopia.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 9
Correct
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A patient presents with an adducted eye at rest which cannot abduct past the midline, which of the following cranial nerves is most likely to be affected:
Your Answer: Abducens nerve
Explanation:Abducens nerve palsies result in a convergent squint at rest (eye turned inwards) with inability to abduct the eye because of unopposed action of the rectus medialis. The patient complains of horizontal diplopia when looking towards the affected side. With complete paralysis, the eye cannot abduct past the midline.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 10
Correct
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Which cervical interspace is most likely injured if a patient presents with difficulty of shoulder abduction and elbow flexion, pain in the right shoulder and lateral arm, and decreased sensation over the deltoid and lateral arm?
Your Answer: C4-C5
Explanation:In the setting of cervical radiculopathy, because the nerve root of a spinal nerve is compressed or otherwise impaired, the pain and symptomatology can spread far from the neck and radiates to arm, neck, chest, upper back and/or shoulders. Often muscle weakness and impaired deep tendon reflexes are noted along the course of the spinal nerve.Cervical radiculopathy is almost always unilateral, although, in rare cases, both nerves at a given level may be impacted. Those rare presentations can confound physical diagnosis and require acceleration to advanced imaging especially in cases of trauma. If there is nerve impingement, the affected side will be reduced relative to the unaffected side. Reduction in strength of muscles innervated by the affected nerve is also significant physical finding.For a C4-C5 injury, the following symptoms may present:Weakness in the deltoid muscle (front and side of the shoulder) and upper armShoulder painNumbness along the outside of the upper arm
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 11
Correct
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A patient presents with a laceration on his hand and wrist that has cut the nerve that innervates opponens pollicis.The opponens pollicis muscle is innervated by which of the following nerves? Select ONE answer only.
Your Answer: The recurrent branch of the median nerve
Explanation:Opponens pollicis is a small, triangular muscle that forms part of the thenar eminence. It originates from the flexor retinaculum and the tubercle of trapezium bone and inserts into the whole length of the first metacarpal bone on its radial side.Opponens pollicis is innervated by the recurrent branch of the median nerve and receives its blood supply from the superficial palmar arch.The main action of opponens pollicis is to flex the first metacarpal bone at the carpometacarpal joint, which opposes the thumb towards the centre of the palm. It also medially rotates the first metacarpal bone at the carpometacarpal joint.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 12
Correct
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A 27-year-old athlete presents with buttock pain after tearing his gluteus maximus muscle.In which of the following nerves is the gluteus maximus muscle innervated by?
Your Answer: Inferior gluteal nerve
Explanation:The gluteal muscles are a group of muscles that make up the buttock area. These muscles include: gluteus maximus, gluteus medius. and gluteus minimus.The gluteus maximus is the most superficial as well as largest of the three muscles and makes up most of the shape and form of the buttock and hip area. It is a thick, fleshy muscle with a quadrangular shape. It is a large muscle and plays a prominent role in the maintenance of keeping the upper body erect.The innervation of the gluteus maximus muscle is from the inferior gluteal nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 13
Incorrect
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A patient presents to ED complaining of pins and needles over the lateral three and a half digits. You suspect carpal tunnel syndrome. Which of the following clinical features would you most expect to see on examination:
Your Answer: Atrophy of the adductor pollicis muscle
Correct Answer: Inability to touch the pad of the little finger with the thumb
Explanation:Compression of the median nerve in the carpal tunnel will result in weakness and atrophy of the thenar muscles – resulting in weakness of opposition, abduction and flexion of the thumb at the metacarpophalangeal joint and anaesthesia or paraesthesia over the distribution of the palmar digital branch of the median nerve (skin over the palmar surface and fingertips of the lateral three and a half digits). The adductor pollicis muscle is innervated by the ulnar nerve, and abduction of the fingers is produced by the interossei, also innervated by the ulnar nerve. Flexion of the interphalangeal joint of the thumb is produced by the flexor pollicis longus, and flexion of the distal interphalangeal joint of the index finger is produced by the flexor digitorum profundus. Median nerve injury at the wrist will not affect the long flexors of the forearm as these are innervated by the anterior interosseous nerve which arises in the proximal forearm.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 14
Incorrect
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Regarding the lung roots, which of the following statements is CORRECT:
Your Answer: The phrenic nerves pass immediately posterior to the lung roots.
Correct Answer: Generally the pulmonary arteries lie superior to the pulmonary veins in the lung root.
Explanation:Each lung root contains a pulmonary artery, two pulmonary veins, a main bronchus, bronchial vessels, nerves and lymphatics. Generally the pulmonary artery is superior in the lung root, the pulmonary veins are inferior and the bronchi are somewhat posterior in position. The vagus nerves pass posterior to the lung roots while the phrenic nerves pass anterior to them.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 15
Incorrect
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An injury to the brachial plexus can cause Erb's palsy. The following is expected to happen to a patient suffering from this condition, except for which one:
Your Answer: Weakness of lateral rotation of the arm
Correct Answer: Weakness of medial rotation of the arm
Explanation:Erb’s palsy can be caused by a traumatic force downward on the upper arm and shoulder that damages the upper root of the brachial plexus. The patient will lose shoulder abduction (deltoid, supraspinatus), shoulder external rotation (infraspinatus), and elbow flexion as a result of this condition (biceps, brachialis).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 16
Correct
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Aside from the inability to extend the leg above the knee, which of the following clinical symptoms should you anticipate seeing in a patient who had a pelvic and right leg injury as well as femoral nerve damage?
Your Answer: Loss of sensation over the anterior thigh
Explanation:The femoral nerve runs down the front of the leg from the pelvis. It gives the front of the thigh and a portion of the lower leg sensation. Extension of the leg at the knee joint, flexion of the thigh at the hip are produced by muscles that is primarily innervated by the femoral nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 17
Correct
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Which of the following is NOT a side effect of phenytoin:
Your Answer: Ototoxicity
Explanation:Adverse effects of phenytoin include:Nausea and vomitingDrowsiness, lethargy, and loss of concentrationHeadache, dizziness, tremor, nystagmus and ataxiaGum enlargement or overgrowthCoarsening of facial features, acne and hirsutismSkin rashesBlood disorders
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 18
Incorrect
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Compression of this nerve can cause weakness in the left leg while walking and thigh adduction weakness at the hip joint.
Your Answer: Inferior gluteal nerve
Correct Answer: Obturator nerve
Explanation:The obturator nerve is a sensory and motor nerve that emerges from the lumbar plexus and innervates the thigh. This nerve supplies motor innervation to the medial compartment of the thigh, making it necessary for thigh adduction.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 19
Correct
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A 64-year-old woman had a humerus midshaft fracture due to tripping on a curb and falling on her left arm. She might also have damaged which of the following structures?
Your Answer: Radial nerve and deep brachial artery
Explanation:The radial nerve and brachial artery are most likely to be damaged in humerus fractures. They are tethered together to the bone and cannot withstand the forces applied to it as a result of the displacement.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 20
Incorrect
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Regarding the abductor pollicis longus, which of the following statements is true?
Your Answer: It arises from the lateral epicondyle of the elbow
Correct Answer: It extends the thumb at the carpometacarpal joint
Explanation:Abductor pollicis longus is a muscle found in the posterior compartment of the forearm. It is one of the five deep extensors in the forearm, along with the supinator, extensor pollicis brevis, extensor pollicis longus and extensor indicis.Abductor pollicis longus is innervated by the posterior interosseous nerve (C7, C8), which is a continuation of the deep branch of the radial nerve. The radial nerve is a branch of the posterior cord of the brachial plexus.Blood supply to the abductor pollicis longus muscle comes from the interosseous branches of the ulnar artery.Acting alone or with abductor pollicis brevis, abductor pollicis longus pulls the thumb away from the palm. More specifically, it produces (mid-) extension and abduction of the thumb at the first metacarpophalangeal joint. This action is seen in activities such as bowling and shovelling.Working together with the long and short extensors of the thumb, the muscle also helps to fully extend the thumb at the metacarpophalangeal joint. This action is important for loosening the hand grip, for example, when letting go of objects previously being held. Abductor pollicis longus also helps to abduct the hand (radial deviation) at the radiocarpal joint.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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SESSION STATS - PERFORMANCE PER SPECIALTY
